Dressler Lynn G, Bell Gillian C, Ruch Karl D, Retamal Jennifer D, Krug Paige B, Paulus Ronald A
Personalized Medicine Department, Mission Health, 9 Vanderbilt Park Drive, Asheville, NC 28803, USA.
Informatics Department, Mission Health, 9 Vanderbilt Park Drive, Asheville, NC 28803, USA.
Pharmacogenomics. 2018 Nov;19(17):1345-1356. doi: 10.2217/pgs-2018-0130. Epub 2018 Oct 22.
The implementation of a de novo personalized medicine program in a rural community health system serving an underserved population is described. Focusing on the safe use of drugs impacted by genetic variations in the non-oncology setting, we first addressed drug-gene pairs designated by the US FDA in black-box warnings (codeine, clopidogrel, abacavir, carbamazepine). The program's first success was a policy change to remove codeine from the pediatric formulary, rather than a testing recommendation. Pilot studies were then conducted with primary care providers to get them familiar with pharmacogenetic testing, and a consultative outpatient clinic for patients was developed. The assessment, planning, implementation, challenges, successes and lessons learned are described.
本文描述了在一个为服务不足人群的农村社区卫生系统中实施全新个性化医疗计划的情况。我们聚焦于非肿瘤环境中受基因变异影响的药物安全使用，首先处理了美国食品药品监督管理局（US FDA）在黑框警告中指定的药物-基因对（可待因、氯吡格雷、阿巴卡韦、卡马西平）。该计划的首个成功之处是一项政策改变，即从儿科处方中移除可待因，而非一项检测建议。随后与初级保健提供者开展了试点研究，以使他们熟悉药物遗传学检测，并为患者设立了一个咨询门诊。文中描述了评估、规划、实施、挑战、成功经验及经验教训。
